Thoracic spine

Around 20,000 cancer patients experience spinal cord compression in the United States every year, most of which involves the thoracic spine (approximately 70%). Cancers that inherently metastasize to bone (e.g., breast, prostate, and lung) are the most frequent etiologies identified. Most spinal cord compression occurs in patients with a known malignancy however, 8% to 34% occurs as the initial presentation of cancer, especially in patients with non-Hodgkins lymphoma, multiple myeloma, and lung cancer.17... 

The spinal cord emerges from the brain stem at the base of the skull and terminates at the second lumbar vertebra. The thoracic spine is most vulnerable to cord compression because of natural kyphosis and because the width of the thoracic spinal canal is the smallest among the vertebrae. Most spinal cord compression is due to adjacent vertebral metastases that compress the spinal cord or from pathologic compression fracture of the vertebra. This results in significant edema and inflammation in the affected area. 

There was kyphosis of the thoracic spine from T7 to T9, with pathological fractures. An MRI scan showed massive epidural fat extending from T1 to T9. She recovered 3 months after surgical removal of the epidural fat. 

Severe pain resulting from a previously asymptomatic thoracic spine metastasis has been attributed to aldesleukin in a 64-year-old man with metastatic renal cell carcinoma (33). 

Swedish authors have summarized cases reported to three Swedish insurance companies within 2 years (178). They found 21 cases associated with the cervical spine, six associated with the thoracic spine, 13 with the lumbar spine, and 14 with the sacro-iliac joints. Cervical spinal manipulation had caused damage to the vertebral artery with subsequent paralysis in three cases and disk herniation in three cases. Lumbar spinal manipulation had caused disk herniation in six cases, three of whom suffered severe and persistent problems. 

A 57-year-old man took prednisone 20-30 mg/day for 13 years for rheumatoid arthritis (45). He had been treated unsuccessfully with gold, azathioprine, hydroxychloroquine, and sulfasalazine tapering his glucocorticoid dosage had been unsuccessful. He developed worsening back pain in his thoracic spine and lateral... 

Metastatic spread can occnr by local extension, lymphatic drainage, or hematogenous dissemination. Lymph node metastases are more common in patients with large, nndifferentiated tumors that invade the seminal vesicles. The pelvic and abdominal lymph node gronps are the most common sites of lymph node involvement (Fig. 128-1). Skeletal metastases from hematogenous spread are the most common sites of distant spread. Typically, the bone lesions are osteoblastic or a combination of osteoblastic and osteolytic. The most common site of bone involvement is the lumbar spine. Other sites of bone involvement include the proximal femurs, pelvis, thoracic spine,... 

Bisceglia M, D Angelo VA, Guglielmi G, et al. Dedifferentiated chordoma of the thoracic spine with rhabdomyosarcomatous differentiation Report of a case and review of the literature. Ann Diagn Pathol. 2007 11 262-272. 

Silverstein AM, Quint DJ, McKeever PE. Intraductal paraganglioma of the thoracic spine. Am J Neuroradiol. 1990 11 614-616. 

Chest accelerometers Thoracic spine load cell... 

Figure 1 False-color scintigram of the human spine and ribs, revealing secondary cancers (metastases) in the vertebrae arising from a primary cancer of the prostate gland. A scintigram (y-camera scan) is a record of radioactive emissions from an isotope (in this case, " Tc) that is selectively absorbed by bone when injected into the body, y-ray scintigraphy is frequently used to screen cancer patients for signs of secondary disease, often after their primary cancer has been treated. Here, the metastases appear as the pink and white hot spots in the thoracic spine. (Reproduced from CNRI/Science Photo Library.)...

The spine is an engine. The axial pull of the muscles on the thoracic and lumbar spine are transformed by coupled motion into axial torque, which is then applied to the pelvis. The spine is now divided into three segments the lumbar spine, which causes the pelvis to rotate the thoracic spine counter-rotates to dissipate torque and utilizes linked movements of the upper extremities in so doing. The cervical spine de-rotates in the opposite direction to allow the head, eyes and sensory organs to have a stable platform which faces the direction of travel. 

These are due to axial compression or flexion injuries and lead to a variable degree of loss of vertebral height The majority of compression fractures in children occur in the thoracic spine (Vialle et al. 2006). These compressions are graded into mild, moderate or severe depending on the degree of compression. 

The majority of patients with upper thoracic spine injuries sustain significant cord injury due to the excessive force necessary to cause this injury and the narrow spinal canal. A significant proportion of these patients develop complete paraplegia. With major fracture dislocations, there is injury to the interspinous ligaments and disc. 

The vertebrae, particularly those of the lumbar spine and thoracic spine, also increase in size. The enlargement involves the anteroposterior axis of the bone more than the lateral axis. Consequently, vertebral enlargement interferes with the patient s flexion, and he has difficulty bending to touch the floor. The increase in skeletal size is not associated with a corresponding increase in muscular strength and, in spite of his frightening appearance, the acromegalic is often feeble and clumsy. 

There exist major differences between the thoracic (Tl-10) and thoracolumbar vertebral bodies (T11-L5), since the rib cage serves as a stabilizer of the thoracic vertebral column. Four factors have to be determined (1) percentage of osteolyses in the vertebral body, (2) presence of involvement of the pedicles, (3) posterior elements, and (4) costovertebral joint involvement at the thoracic spine (Taneichi et al. 1997). 

A vertebral body is at risk of fracture in the thoracic spine if more than 50% of the vertebral body is missing or if more than 25% of osseous destruction of the vertebral body is combined with a destruction of the costovertebral joint (see above Fig 35.14). In the lumbar spine, a vertebral body is at risk of fracture if more than 35% of the body is destroyed or if a more than 20% de-... 

Vertebral body (Fig. 37.9) depending on the vertebral level, the access path is anterior (cervical spine), transpedicular or intercostovertebral (thoracic spine), and transpedicular or posterolateral (lumbar spine). 

When biopsies are performed in thoracic lesions, the operator should always be cautious of a possible pneumothorax at the end of the procedure, either a followup CT scan or an expiratory chest radiograph should be obtained to rule out a pneumothorax. A chest tube kit should be available before biopsy of the thoracic spine. 

The advantage in combining CT and fluoroscopy is the precise needle placement, which is particularly important in the upper thoracic spine, tumor cases, and other difficult cases. This dual-guidance technique reduces complications and increases the comfort and the confidence of the interventional radiologist. It allows for visualization in three dimensions with exact differentiation of anatomic structures at risk. Fluoroscopy is provided by placing a mobile C-arm in front of the CT gantry. When the position of the needle tip is considered satisfactory, the imaging mode is switched to C-arm fluoroscopy for real-time visualization of cement application in an AP and lateral view. 

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